If you are interested in applying to be a member of the Chick-fil-A Mom Panel, please fill in the fields and answer the questions below.

Contact Information

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* 1. Contact Information

Please select your age group from the categories below.

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* 2. Please select your age group from the categories below.

Please indicate the number of children in your household.

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* 3. Please indicate the number of children in your household.

Please select the age of your children. Select all that apply.

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* 4. Please select the age of your children. Select all that apply.

What is your ethnicity?

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* 5. What is your ethnicity?

How would you classify your current career status?

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* 6. How would you classify your current career status?

What kind of school(s) do your child(ren) attend? Please select all that apply.

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* 7. What kind of school(s) do your child(ren) attend? Please select all that apply.

Were you a part of the 2016-17 Chick-fil-A Mom Panel?

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* 8. Were you a part of the 2016-17 Chick-fil-A Mom Panel?

Please share links for your social media channels/accounts below to those that apply.

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* 9. Please share links for your social media channels/accounts below to those that apply.

Please share metrics for your social media channels/accounts below to those that apply.

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* 10. Please share metrics for your social media channels/accounts below to those that apply.

Approximately how many moms do you communicate with OFFLINE on a weekly basis? (through school, PTA/PTO, moms groups, athletic leagues, workplace, etc.)

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* 11. Approximately how many moms do you communicate with OFFLINE on a weekly basis? (through school, PTA/PTO, moms groups, athletic leagues, workplace, etc.)

Please tell us about any other ways you connect with Moms. (Example: Playgroup and meet 30-40 moms each week or month; Write for a parenting publication that reaches 30K families each month, etc.)

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* 12. Please tell us about any other ways you connect with Moms. (Example: Playgroup and meet 30-40 moms each week or month; Write for a parenting publication that reaches 30K families each month, etc.)

Please indicate which of the following positions/titles you hold and/or participate in. Please select all that apply:

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* 13. Please indicate which of the following positions/titles you hold and/or participate in. Please select all that apply:

Are you currently partnering with any other brands or companies?

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* 14. Are you currently partnering with any other brands or companies?

How often do you frequent Chick-fil-A?

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* 15. How often do you frequent Chick-fil-A?

On a scale of 1 to 5, with 5 being extremely positive, how would you rate your overall impression of Chick-fil-A?

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* 16. On a scale of 1 to 5, with 5 being extremely positive, how would you rate your overall impression of Chick-fil-A?

How often do you take advantage of the following Chick-fil-A services?

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* 17. How often do you take advantage of the following Chick-fil-A services?

  Weekly Twice a Month Once a Month A Few Times a Year Never
Kid's Meals
Playground
Trays/Catering
Family Night Events
Community Events
Wifi
How often do you discuss Chick-fil-A with family and friends?

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* 18. How often do you discuss Chick-fil-A with family and friends?

What is it that you love most about Chick-fil-A?

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* 19. What is it that you love most about Chick-fil-A?

What would you like to see more of at Chick-fil-A?

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* 20. What would you like to see more of at Chick-fil-A?

Is there anything else you’d like to tell us about why you’d like to be a part of the Chick-fil-A Mom Panel?

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* 21. Is there anything else you’d like to tell us about why you’d like to be a part of the Chick-fil-A Mom Panel?

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